Provider First Line Business Practice Location Address:
945 SOUTH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUSTER CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-362-6565
Provider Business Practice Location Address Fax Number:
814-362-6415
Provider Enumeration Date:
08/06/2007